Missouri Form 4803 – Fill Out and Use This PDF

Requester

Owner

Driver’s Privacy Protection Act (DPPA) - To obtain the name and address on motor vehicle and marine titling and registration records, you must provide your DPPA access number in the box below. All previous owner information is restricted. If you do not have an access code, please submit a Request for Security Access Code (Form 4678). Form 4678 will inform you of who may receive a security access code.

Name of Individual or Organization		Requestor’s Name - Last, First, Middle Initial
Street Address, R.R., Or P.O. Box Number		City		State	ZIP Code
Fax Number	Telephone Number		DPPA Access Number
(__ __ __)__ __ __-__ __ __ __	(__ __ __)__ __ __-__ __ __ __

The owner’s address must be provided to obtain a list of motor vehicle or marine craft owned by this individual.

Name - Last, First, Middle Initial

	Street Address, R.R., Or P.O. Box Number	City	State	ZIP Code

Motor Vehicle

Year

Make

Title Number

1

__ __ __ __

Vehicle Identification Number

License Plate Number

Expiration Year

__ __ __ __

Year

Make

Title Number

2

__ __ __ __

Vehicle Identification Number

License Plate Number

Expiration Year

__ __ __ __

Marine Craft

Year

Make

Decal Number

Expiration Year

1

__ __ __ __

__ __ __ __

Identification Number

Additional Information

Year

Make

Decal Number

Expiration Year

2

__ __ __ __

__ __ __ __

Identification Number

Additional Information

Requested Information

Payment Options

Please select below the type of information you want to receive. A brief explanation of information this office will provide follows each type of request.

rCurrent Owner (You must provide the license plate number or marine decal number or year, make, and identification number.) You will receive only the name and address of latest owner on file (subject to DPPA as noted above), in addition to the vehicle information and any lienholder of record.

rTitle History (You must provide the year, make and identification number.) You will receive a list that shows each time the ownership changed in this state. The list will include the owner’s name and address (subject to DPPA as noted above) and the title number, issue date, and mileage.

rMileage History (You must provide the year, make and identification number.) You will receive a list that shows each time the ownership changed in this state. The list will include the mileage, title number, and issue date.

rStatus of Title (Free only to current vehicle owner; however, you must provide a copy of your registration receipt you received when you applied for title.)

rName History (You must provide the owner’s name and address.) You will receive a list of the current vehicles registered in that owner’s name.

rCertified request for record information.

Please send the above record(s) by: r Mail r Fax (Add $0.50 per page faxed)

Records can be obtained by walk-in, mail-in, or e-mail request. The fee is $2.82 per record. A convenience fee will be charged for credit or debit card transactions.

Cash

Check

Money

Debit

Discover

Visa

American

Mastercard

Total Record Fees

Convenience Fee

Order

Card

Express

$0.00 - $50.00

$1.25

Central Office Visit

$50.01 - $75.00

$1.75

Mail

$75.01 - $100.00

$2.15

Fax or E-Mail

$100.01 or more

2.15%

If you are paying by credit or debit card you must provide the following:

Name (as it appears on card)

Card Type

Card Number

Expiration Date

__ __ /__ __

Signature

I understand that Section 302.183.2, RSMo, (HB 361 effective August 28, 2009) prohibits the sale of data derived from a person’s application for commercial purposes, which includes purposes motivated primarily by financial gain such as, but not limited to, surveys, marketing or solicitations, without the express consent of the person to whom such information pertains. The Missouri Department of Revenue may electronically resubmit checks returned for insufficient or uncollected funds.

Requestor’s Signature	Printed Name of Requestor		Date (MM/DD/YYYY)
			__ __ /__ __ /__ __ __ __
		Form 4803 (Revised 07-2016)